| NPI | 1811410541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020024095) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017015272) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2022-07-21 |